COmplexity of CARE and Discharge barriers: the 'modern internal medicine patient'. Results from the CO-CARED Study.

Autor: Ceriani E; Internal Medicine Department, Ospedale Luigi Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy. elisa.ceriani@asst-fbf-sacco.it., Milani O; Internal medicine Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy., Donadoni M; Internal Medicine Department, Ospedale Luigi Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy., Benetti A; Internal Medicine Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy., Berra SA; Internal Medicine Department, Azienda Ospedaliera Salvini, Garbagnate Milanese, Italy., Canetta C; High Care Internal Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy., Colombo F; Internal Medicine Department, Ospedale Niguarda, Milan, Italy., Dentali F; Internal Medicine Department, ASST Settelaghi, Varese, Italy., Magnani L; Internal Medicine Department, ASST Pavia, Voghera, Italy., Mazzone A; Internal Medicine Department, ASST Ovest Milanese, Legnano, Italy., Montano N; Internal medicine Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy., Muiesan ML; Internal Medicine Department, ASST Spedali Civili Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Podda GM; Internal Medicine Department, ASST Santi Paolo e Carlo, Milan, Italy.; Dipartimento di Scienze Della Salute, Università degli Studi di Milano, Milan, Italy., Querini PR; Internal Medicine Department, IRCCS Ospedale San Raffaele, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy., Squizzato A; Internal Medicine, Ospedale Sant'Anna ASST Lariana, University of Insubria, Como, Italy., Casazza G; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy., Cogliati C; Internal Medicine Department, Ospedale Luigi Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy.; Department of Clinical Sciences and Health Community Università degli Studi di Milano, Milano, Italy.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2024 Dec 10. Date of Electronic Publication: 2024 Dec 10.
DOI: 10.1007/s11739-024-03823-0
Abstrakt: The ongoing demographic, epidemiological and social changes are dramatically raising the clinical and care complexity of patients admitted to internal medicine (IM) departments. Collecting evidence for a better characterization of patients is crucial to tailor future interventions based on patient's real needs. The aim of this prospective multicenter study was to describe the complexity of care of patients hospitalized in IM by calculating the complexity of care (ICC) score, through the combination of clinical instability (NEWS score) and care dependency scales (mICD). Furthermore, social frailty was assessed according to potential difficulty in discharge planning. 3912 patients were enrolled (median age 78 years); 71% had a Charlson Comorbidity Index ≥ 5. The ICC score was high in 14.7% of patients, while 15% exhibited a NEWS score at least moderate. One in four patients presented moderate to critical social frailty. The length of stay was correlated with social frailty, mICD and ICC scores, but not with NEWS. In-hospital mortality was correlated with the severity of all the considered scores. A relevant proportion of IM patients exhibited a high complexity of care. Our data support a model in which approximately 15% of IM beds are designated for clinically unstable patients managed in intermediate care sub-units. The substantial burden of social frailty highlights the urgency of national plans allowing at the same time to cover the needs of not self-sufficient and socially disadvantaged patients, and to efficiently address the issue of emergency department boarding.
Competing Interests: Declarations. Informed consent: Writteninformed consent was obtained for all study participants; in case of impossibility to sign the informed consent, such as in severely ill patients or patients with dementia, informed consent was signed by patient’s legal guardian. Human and animal rights statement: The study complied with the ethical standards of the Helsinki Declaration. Conflict of interest: The authors declare that they have no conflict of interest.
(© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
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